Name of Manual - Blue Cross and Blue Shield of Minnesota

Claims Filing
Cancel/Void and
Replacement Claims
(continued)
Scenario 2
If you have not received a HIPAA compliant remittance
advice (835) from the previous payer, you may send a
replacement claim transaction with the addition of the
PWK segment and send the paper remittance advice from
the previous payer as an attachment.
Note: All Minnesota Group Purchasers must provide a
HIPAA and State of Minnesota compliant
remittance advice, and providers are required by the
Minnesota Uniform Companion Guides (section
4.2.3.5) to submit the previous payment information
electronically using the proper fields within the
claim transactions.
Additional Information
For additional information on these types of claims, please refer to
the Minnesota Uniform Companion Guides and related Best
Practice documentation on the AUC website at
health.state.mn.us/auc/guides.htm.
8-32 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12)